Appendix: TES Volunteer Application

Trinity Episcopal School Volunteer Application

Please note: 

• If you are driving on field trips or to Middle School sports practices and games with children other than your own, you need to complete Sections One and Two of the Volunteer Application form.

• If you have attended or viewed a Volunteer Training Session before, you do not need to view it again.  If you have not, you can check out a DVD at the front desk or access it at www.youtube.com by searching for “Trinity Episcopal School”.

• If you will be one-on-one with students in a job such as a coach, tutor or chaperone on an overnight field trip (such as Earthshine [fourth-grade], Green River Preserve [fifth-grade], Mission Trips or other school-sponsored trips) you will be contacted for additional background check authorization.

SECTION 1:  All volunteers Authorization to conduct Sex Offender Background Check

Student/s Name/s ________________________________________________ Grade/s _____________________

 
Applicant’s First Name __________________ Middle or Maiden Name______________ Last Name_________________

Home Address________________________________________________________ City State______ ZIP___________

Have you ever been convicted of a crime (other than minor traffic offenses)? Yes_____ No_____ (If yes, please explain the charges and where and when they occurred: ______________________________________________________________

Sex: _______________ Date of Birth:_________________

List all other residential addresses for the past 3 years:

Street Address                                       City/State/County                                                          Zip Code                Dates

________________________________________________________________________________________________

________________________________________________________________________________________________
I authorize Trinity Episcopal School and their agents to conduct a sex offender records search on myself as part of my application for volunteering. This may include information contained in criminal files at the county, state and federal jurisdictions.  I hereby release and hold harmless Trinity Episcopal School, all persons, companies or corporations furnishing such information from liability and responsibility.

My signature indicates that all information provided here is, to the best of my knowledge, true and accurate. I agree to notify the school of any adverse changes to information provided herein. I understand that if I volunteer for any school function, event,  field trip or excursion, that my personal Automobile, Liability, or Medical Insurance shall serve as primary coverage, with Trinity Episcopal School’s Insurance serving as secondary coverage, in the event of any and all liability, loss, damages, claims, or actions for bodily injury and/or property damage

Signature: ___________________________________________     Date: _________________

SECTION 2:  Driving Students (complete SECTION 1 also) Authorization to conduct Driver’s License Check

Driver’s License Number_______________________  License State _______________

Current Auto Insurances (Carrier and Policy number):  _____________________________________________________

I authorize Trinity Episcopal School and their agents to conduct a driver’s license record search on myself as part of my application for volunteering.  I hereby release and hold harmless, Trinity Episcopal School, all persons, companies or corporations furnishing such information from liability and responsibility. My signature indicates that my Drivers License is active and in good standing,  and that I have current liability insurance as required by the State of North Carolina.

Signature: ___________________________________________     Date: _________________